Thyroid function post laryngectomy and hemithyroidectomy - do all laryngectomy patients need thyroid replacement?

Hypothyroidism is a common complication following laryngectomy with hemithyroidectomy, with a varying incidence between 44-89% amongst this group of patients 1–7. It is often underrecognized due to the insidious onset of thyroid dysfunction and relatively non-specific nature of hypothyroid symptoms. Hypothyroidism may be detrimental to wound healing and be associated with an increased risk of fistula formation, particularly in salvage cases 4,6

Although patients that undergo total thyroidectomy at the time of laryngectomy will be prescribed empirical thyroid replacement with serial thyroid function tests (TFTs), there is no clear consensus on the management of patients undergoing hemithyroidectomy at the time of their laryngectomy. Guidance from the British Thyroid Association suggest that TFT’s should be checked 6-8 weeks following a hemi or total thyroidectomy 8, with these recommendations being commonly adopted for laryngectomy patients undergoing the aforementioned.

The aim of this study was to determine the incidence and risk factors for post-treatment hypothyroidism in patients treated with laryngectomy and hemithyroidectomy for head and neck squamous cell cancer (HNSCC), and would represent the largest study to date looking exclusively at this subgroup of patients.